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In this video I explain the 3 sources of pain arising from the back of the heel. This is a very common problem and I add a few tips on how to minimize pain back there.
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Many patients ask themselves, “Do I have plantar fasciitis?” Many patients assume they have plantar fasciitis as it is a fairly well known term but there are many types of heel pain. The types of heel pain shown in the video are the most common types of heel pain we see in the office. Based on the location and the type of pain you are experiencing, it is easy to differentiate between let’s say plantar fasciitis or achilles tendonitis, and plantar fasciitis or fat pad syndrome. Once you have a proper diagnosis, then you can go about treatment for heel pain successfully.

One question we often get asked is if a patient has plantar fasciitis or heel spur. The reality is, is that people may have heel spurs and never have pain in the heel. Or patients may have plantar fasciitis symptoms and are also told they have a heel spur after receiving an x-ray. A heel spur is only present if there has been enough tension or pulling from the plantar fascia which causes the heel bone to elongate at the plantar fascia attachment site. Patients may experience plantar fasciitis pain with a heel spur or they may not. Treatment is same if a patient has plantar fasciitis or heel spur.

Less common types of heel pain but still seen in the clinic are peroneal tendonitis and posterior tibialis tendonitis. Peroneal tendonitis can affect the outer portion of the heel while posterior tibialis tendonitis (or flexor tendonitis) can affect the inner heel area.

Are you looking for a diagnosis for the type of heel pain you are experiencing? Schedule with one of our sports chiropractors today! We are conveniently located in Mission Valley, San Diego.

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Heel pain can come from plantar fasciitis, heel spurs (or bone spurs), & Achilles tendonitis. It can also be caused by muscle imbalances or alignment issues higher up in the knee, hip, or back. Buy FitMyFoot custom footwear at https://www.pntra.com/t/SENJS0hNR05DSEZGSUtJQ0dNSkZMSA (affiliate link) Buy a worksheet with these heel pain relief treatments at https://www.askdoctorjo.com/heel-pain-worksheet

Stretching the bottom of the foot, or the plantar fascia, with a ball, foam roll, or frozen water bottle can help loosen up the area and take pressure off the heel. Then massage the plantar fascia. A fanning or spreading motion from the midline outwards helps relief the pain in the area.

Next, using a stretch strap, belt, or dog leash, stretch the calf muscles. The Achilles tendon that’s attached to the calf can also cause heel pain, so this is a great stretch to help take pressure off the area.

Then in standing, a runner’s stretch for the calf, and then the stretch for the soleus are also great stretches for the lower leg.

Finally, heel raises are some exercises to help strengthen the muscles.

Related Videos:

Plantar Fasciitis Treatment with Massage, Stretches, & Exercises:

Plantar Fasciitis Stretches & Exercises:

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Doctor Jo is a Physical Therapist and Doctor of Physical Therapy.

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Easy Heel Pain Relief:

https://www.askdoctorjo.com/heel-pain-relief

00:00 – Heel Pain Relief
01:09 – Plantar Facia Stretch with Foam Roll/Ball
02:07 – Plantar Fascia Massage
03:19 – Calf Stretch

05:00 – Runner’s Stretch
06:00 – Soleus Runner’s Stretch
06:48 – Heel Raises

DISCLAIMER: This content (the video, description, links, and comments) is not medical advice or a personalized treatment plan and is intended for general education and demonstration purposes only. Perform the moves in this content at your own risk. These moves may not be appropriate for your specific situation, so get approval and guidance from your own healthcare provider before beginning. If anything is painful or doesn’t feel right, stop immediately and contact your healthcare provider.

Don’t use this content to self-diagnose or self-treat any health, medical, or physical condition. Don’t use this content to avoid going to your own healthcare provider or to replace the advice they give you. You agree to indemnify and hold harmless Ask Doctor Jo, LLC, its officers, employees, and contractors for any and all losses, injuries, or damages resulting from any and all claims that arise from your use or misuse of this content. Ask Doctor Jo, LLC makes no representations about the accuracy or suitability of this content.

PRODUCT PLACEMENT DISCLAIMER: This video contains paid product placement and Affiliate links. Thank you to FitMyFoot for sponsoring this video and providing Doctor Jo with a free Custom Footwear to use. Ask Doctor Jo earns a commission from qualifying purchases.
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Dr. Ebraheim’s educational animated video describes different causes of heel pain.
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Heel pain is an extremely common complaint with several common causes.
1. Plantar fasciitis (the most common cause)
2. Baxters nerve compression (a rare cause)
3. Fat pad atrophy
4. Achilles tendonitis
5. Haglund’s deformity
6. Stress fractures of the calcaneus
7. Tarsal tunnel syndrome
8. Lumbosacral spine radiculopathy
So it is difficult to determine the source of the pain and this makes diagnosis difficult or confusing. The most common cause is plantar fasciitis. Plantar fasciitis is irritation and swelling of the thick tissue on the bottom of the foot. This fascia can become inflamed and painful, making walking more difficult. Plantar fasciitis is most severe in the morning. The start up pain symptoms is more severe for the first out and persist with activity through the day. Pain symptoms will intensify with prolonged exercise or standing. There will be tenderness over the plantar medial heel with negative Tinel’s sign. X-ray may show a plantar heel spur. Plantar fasciitis is usually associated with a tight heel cord.
The Baxters nerve. It is the first branch of the lateral plantar nerve. The Baxters nerve contributes to 20% of all heel pain cases in this nerve provides motor innervation to the abductor digiti minimi muscle. The nerve courses vertically between the abductor hallucis and the quadratus plantae muscles, then makes a 90 degree horizontal turn, coursing laterally beneath the calcaneus to innervate the abductor digiti minimi muscle. Involvement of the Baxters nerve may affect running athletes causing pain on the medial plantar aspect of the foot. Entrapment of the Baxters nerve is usually overlooked or misdiagnosed.
Fat pad atrophy. The fat pad cushions the calcaneus and in the condition of fat pad atrophy, the fact that cushions the calcaneus is thinned so the calcaneus loses its cushion. This condition is common in elderly people and can cause significant pain while walking. There is always a history of steroid injections. The injections are commonly used to treat plantar fasciitis and they can cause this heel pad atrophy. Patient will have pain when walking. The pain is deep, central, nonradiating plantar heel pain that is worsened when the patient is barefoot and resolves when the patient walks on her toes, with tenderness at the central aspect of the heel pad.
Achilles tendonitis
The patient will have ankle pain for several months (chronic condition).
The patient will complain of pain and swelling because the tendon is thickened with tenderness to palpation about the top of the calcaneus.
Haglund’s deformity
The Haglund’s deformity is an insertional calcification and exostosis at the insertion of the Achilles tendon. The patient is usually treated by physical therapy and noninflammatory medication. Do not injection through the tendon, rather inject around the tendon. If the symptoms persist beyond 6 months, then surgery may be needed with excision of the Haglund’s exostosis and insertional calcification. If more than 50% of the Achilles tendon is detached to remove the posterosuperior calcaneus prominence, and the tendon becomes weak and should be secured to the bone of the calcaneus with suture anchors or tendon transfer to bridge the gap. The operation will be an Achilles tendon debridement, calcaneal exostectomy and FHL tendon transfer, especially if the tendon degeneration is greater than 50% of the width.
Stress fracture of the calcaneus
The stress fractures of the calcaneus can occur due to overuse injuries. The patient will complain of heel pain, severe weightbearing pain in the patient increases with walking and running. The pain associated with the calcaneal stress fracture does not improve throughout the day and each step is painful. The pain is more with medial to lateral compression of the calcaneal tuberosity.
Compression tests or squeeze test
X-ray can be normal. We may need to get an MRI to diagnose the stress fracture of the calcaneus.
Tarsal tunnel syndrome
Paresthesia and numbness in the plantar foot. Symptoms are worse with activity and the paresthesia may wake the patient up at night.
Ganglion cyst of the ankle (tarsal tunnel syndrome). – Known cause of tarsal tunnel syndrome. Check the MRI.
The patient will respond well and have a favorable outcome to excision of the ganglia and the patient may have resolution of the tarsal tunnel syndrome symptoms.
Lumbosacral spine radiculopathy
Pain on the lateral side of the foot can result from L5-S1 herniated disc (will cause radiculopathy). The S1 nerve root supplies the lateral aspect of the foot. Pain on the lateral side of the foot can result from L5-S1 herniated disc. The S1 nerve root involvement causes decreased sensation and pain on the lateral aspect of the foot.
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Heel pain can be caused by a number of things such as heel spurs (or bone spurs), Achilles tendonitis, and plantar fasciitis. These treatments should help relieve the pain. Purchase the heel seats featured in this video here: http://www.askdoctorjo.com/heel-pain-heel-spurs

One of the treatments featured in this video is using heel inserts. The folks at Heel That Pain sent me their heel seats. Their heel seats have extra cushioning and support to help take pressure off the heel and the Achilles tendon. They come in various sizes and are easy to add to your existing shoes.

Related Videos:

Plantar Fasciitis Treatment with Massage, Stretches, & Exercises:

Plantar Fasciitis Stretches & Exercises:

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5 Best Heel Pain & Heel Spur Treatments:

DISCLAIMER: This content (the video, description, links, and comments) is not medical advice or a treatment plan and is intended for general education and demonstration purposes only. This content should not be used to self-diagnose or self-treat any health, medical, or physical condition. Don’t use this content to avoid going to your own healthcare professional or to replace the advice they give you. Consult with your healthcare professional before doing anything contained in this content. You agree to indemnify and hold harmless Ask Doctor Jo, LLC and its officers for any and all losses, injuries, or damages resulting from any and all claims that arise from your use or misuse of this content. Ask Doctor Jo, LLC makes no representations about the accuracy or suitability of this content. Use of this content is at your sole risk.

PRODUCT PLACEMENT DISCLAIMER: This video contains paid product placement. Thank you to Heel That Pain for sponsoring this video and providing Doctor Jo with a free Heel Seats to use.

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Hi, I’m Dr. Zimmerman. I’m a foot and ankle specialist here to talk to you about plantar fasciitis today (also known as heel pain).

Plantar fasciitis or heel pain is generally pain in the bottom or the plantar side of the person’s foot. Typically patients have sharp shooting pain, generally worse in the morning or right after walking, in the bottom of their foot.

On the bottom of your foot there’s a plantar fascia, which is a fibrous band that goes from your toes back to your heel. A lot of time people have pain in this portion of their heel associated with plantar fasciitis.

Plantar fasciitis generally is treated with conservative treatment, which can consist of:

1. Stretching
2. Icing
3. Appropriate shoe gear
4. Shoe inserts
5. Anti-inflammatories

When the patient is still having pain in that area, sometimes an injection into the area can also help. Generally if we continue to have pain and conservative treatment is not working, we move on to potentially doing an MRI or an ultrasound of the band. Depending on what that shows sometimes surgery is indicated. Surgery would potentially be indicated for a thick band that has not been improved with conservative treatment, and a lot of times the treatment for that is actually releasing the plantar fascia, similar to a carpal tunnel surgery.

Patients many times have heard that plantar fasciitis has also been referred to as heel spur syndrome. Patients get an x-ray and see on the bottom of their heel, they may see a spur. Through research and time we have learned that the heel spur itself is actually not the cause of the pain, but rather the plantar fascia, and that’s why an important aspect of the whole treatment plan is stretching and wearing appropriate shoes.

If this is something you’ve been experiencing and your pain is not getting any better I do recommend seeing a foot and ankle specialist.

https://www.chihealth.com/footankle

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